Prevalence and diagnostic reclassification of sarcopenia in type 2 diabetes according to AWGS 2019 and AWGS 2025 criteria: a secondary cross-sectional analysis

Abstract

Sarcopenia is common in patients with type 2 diabetes mellitus (T2DM). In 2025, the Asian Working Group for Sarcopenia (AWGS) updated its diagnostic criteria by removing physical performance from the diagnostic algorithm and introducing BMI-adjusted appendicular skeletal muscle mass (ASM). These changes may influence sarcopenia detection in populations with altered body composition, including those with T2DM. This study compared sarcopenia prevalence and diagnostic transitions between AWGS 2019 and AWGS 2025 in patients with T2DM. This study represents a secondary analysis of an existing cross-sectional dataset collected between February and November 2025. Participants were adults aged 40–90 years with T2DM treated for at least one year. Body composition was assessed using multi-frequency bioelectrical impedance analysis, and handgrip strength and physical performance were evaluated using standardized protocols. Sarcopenia was defined using the AWGS 2019 and 2025 criteria. Prevalence, clinical characteristics, and diagnostic transitions were compared. Among 250 participants (mean age 65.1 ± 8.5 years; mean BMI 27.9 ± 5.5 kg/m²), sarcopenia prevalence was substantially higher using the AWGS 2025 than the AWGS 2019 criteria (48.4%, 95% CI 42.2–54.6 vs. 23.2%, 95% CI 18.4–28.9; McNemar p  < 0.001). Overall agreement between the two classifications was 66.0% (Cohen’s κ = 0.31). Increases were observed across most age groups. Patients classified as sarcopenic according to the AWGS 2025 criteria had higher BMI, consistent with the incorporation of BMI-adjusted ASM in the revised criteria, as well as more frequent insulin use and higher uACR. Diagnostic transitions showed that 74 patients (29.6%) met the AWGS 2025 criteria for sarcopenia but not the AWGS 2019 criteria. The AWGS 2025 criteria classified substantially more patients with T2DM as having sarcopenia than the AWGS 2019 criteria. Participants additionally identified under the AWGS 2025 criteria exhibited distinct metabolic characteristics, including more frequent insulin use and elevated uACR. Further longitudinal studies are needed to determine the clinical relevance of these diagnostic reclassifications. Not applicable. This study is a secondary analysis of previously collected cross-sectional data and does not involve any health care intervention.